Citation Nr: 20003853 Decision Date: 01/15/20 Archive Date: 01/15/20 DOCKET NO. 17-04 283 DATE: January 15, 2020 ORDER Entitlement to service connection for right lower extremity swelling and pain is granted. Entitlement to service connection for left lower extremity swelling and pain is granted. REMANDED Entitlement to service connection for a right shoulder condition is remanded. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran’s favor, right lower extremity swelling and pain is related to her active service. 2. Resolving reasonable doubt in the Veteran’s favor, left lower extremity swelling and pain is related to her active service. CONCLUSIONS OF LAW 1. A lower right lower extremity condition causing swelling and pain was incurred on active duty service. 38 U.S.C. §§ 101(24), 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 2. A left lower extremity condition causing swelling and pain was incurred on active duty service. 38 U.S.C. §§ 101(24), 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from June 1986 to August 1992. The RO initially denied the claim for service connection for bilateral lower extremity in an unappealed November 2007 rating decision. Thereafter, in January 2014, the Veteran filed a claim to reopen the previously denied claim for service connection, which was denied in the July 2014 rating decision currently on appeal. During the course of this appeal, VA received additional service personnel and treatment records regarding the Veteran’s service. Where VA receives relevant official service department records that existed and had not been associated with the claims file when VA first decided a claim, VA will reconsider the claim, notwithstanding the requirement of new and material evidence. See 38 C.F.R. § 3.156(c). Therefore, because additional service department records are now included in the record, the finality of any previous decision is vitiated by these records and the Veteran is not required to submit new and material evidence before consideration of the claims on a de novo basis. Service Connection With respect to the Veteran’s claim herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326; see also Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). Service connection means that a disability resulting from disease or injury was incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge if the evidence shows that the disease was incurred in service. 38 C.F.R. § 3.303(d). Active military service includes active duty, or any period of active duty for training during which the individual concerned was disabled from a disease or injury incurred in the line of duty. 38 U.S.C. § 101 (24); 38 C.F.R. § 3.6 (a). Entitlement to service connection benefits is established when the following elements are satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and, (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service (the medical “nexus” requirement). See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); 38 C.F.R. § 3.303(a). For certain disabilities, service connection may be presumed when such disability is shown to a degree of 10 percent or more within one year of a veteran’s discharge from active duty. 38 U.S.C. § 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Entitlement to service connection for right and left lower extremity swelling and pain. The Veteran asserts that right and lower extremity swelling and pain was incurred subsequent to the performance of her duties as a truck driver while in service, and alternatively, following and injury that occurred while on active duty. The Veteran explains that her position as a truck driver required her to jump in and out of vehicles, including tanks, trucks, and tractors, which ultimately caused injury to her legs. Additionally, the Veteran reports that she sustained injury to her lower back after a falling a distance of approximately 5 feet from the back of a truck, after which she experienced immediate onset of severe pain of the lower back with radiating pain down the leg which contributes to her current lower right and left extremity pain. See July 12, 2013 VA treatment record. A review of the service treatment records show treatment for lower extremity edema beginning in July 1986. Various etiologies were considered; however, no etiology was confirmed during active duty service. The Veteran explained in a September 2019 Board hearing that she experienced a continuity of symptomatology of right and lower extremity swelling and pain following separation from active duty service. A review of VA treatment records shows that the appellant received an evaluation in 2014 and sought treatment for mild venous insufficiency in 2016. An October 1992 VA examination documented edema of both ankles, and complaints of swelling and pain in the ankles and feet. A July 2007 VA examination notes chronic edema in the feet extending to the legs bilaterally. During a January 2017 VA examination in January 2017, the appellant again reported a history of right and left lower extremity swelling and pain that persisted since active duty service. The examiner remarked that the Veteran’s lower extremity edema has been present for over thirty years and that swelling and pain is present today. Following the examination, the examining physician diagnosed bilateral venous varicosities., however, the examiner failed to discuss whether the veteran’s multiple evaluations of lower extremity edema as well as her reports of continuous symptomatology could have been evidence of the evidence of her current condition. The Board finds that a continuity of symptomatology is established and entitlement to service connection is warranted under the doctrine of reasonable doubt. The evidence shows that the appellant injured her lower extremities while on active duty in February 1988. See Service Treatment Records. There is no evidence that the appellant experienced a post-service injury that may have played a role in the etiology of the disorder at issue, thus the Board finds that the evidence is in equipoise. Hence, entitlement to service connection for right and lower extremity pain and swelling is granted. Wise v. Shinseki, 26 Vet. App. 517, 531 (2014). (“By requiring only an ‘approximate balance of positive and negative evidence’..., the nation, ‘in recognition of our debt to our veterans,’ has ‘taken upon itself the risk of error’ in awarding... benefits.”). REASONS FOR REMAND Entitlement to service connection for a right shoulder condition is remanded. Following its review of the record, the Board finds that additional development is required before the Board decides the Veteran’s claim for a right shoulder condition. The Veteran asserts that her right shoulder condition is related to active service. She explains that she injured her shoulder while on active duty in February 1988 after falling off a truck. Specifically, the Veteran stated that she injured her body, including her right shoulder, requiring her to visit the emergency room as a result of the injury. Service treatment records reflect treatment for pain due to failing off a truck. The Veteran states that her right shoulder pain continued since the initial injury and has worsened over the years since her separation from service. Despite the foregoing the Veteran has not been afforded a VA examination as part of her current claim. The Board finds that a VA examination is necessary to determine the etiology of any current right shoulder condition. As such, further development is in order. The matter is REMANDED for the following action: 1. A VA Notify the Veteran that she may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of her in-service and post-service right shoulder condition. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 2. Afford the Veteran a VA examination to determine whether it is at least as likely as not that she has right shoulder condition that had its onset or is otherwise related to service. After a review of the claims file, the examiner should opine as to whether it is at least as likely as not that the Veteran’s right shoulder disability is related to or had its onset in service. In offering this opinion the examiner must acknowledge and discuss the Veteran’s competent report of the onset of a right shoulder condition during her active duty service. If the examiner feels that the requested opinions cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Booker, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.